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CLINICAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH CONDUCT PROBLEMS ADMITTED INTO A PSYCHIATRIC UNIT (소아정신과 병동에 입원한 품행장애 소아 청소년의 임상 특성)

  • Pyo, Kyung-Sik;Kang, Yun-Hyong;Bahn, Geon-Ho;Cho, Soo-Churl;Lee, Eun-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.2
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    • pp.227-236
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    • 1998
  • Objectives:Conduct disorder is one of the most frequent diagnosis in outpatient and inpatient mental health facilities for children and adolescents. This study investigated the clinical characteristics of children and adolescents with conduct disorder. Methods:The study employed a retrospective review of 45 inpatients diagnosed with conduct disorder by DSM-IV criteria at SNUH Child Psychiatric Unit from 1993, March to 1998, September. Results:The results were as follows:1) The sex ratio was 2:1, male dominant. Mean age on admission was $12.8{\pm}2.4$ years old(male:$12.2{\pm}2.3$, female:$14.1{\pm}2.1$). The mean age of male subjects was significantly lower than that of female subjects(p<.05). 2) We classified all subjects according to child- or adolescent-onset type by DSM-Ⅳ. Childhoodonset type was 42.2%, and adolescent-onset, 57.8%. The onset of male subjects were significantly earlier than that of female subjects(p<.05). 3) The most common complaint was 'serious violation of rules'(77.8%) by DSM-Ⅳ dimensions, while the most common single symtom was 'run away from home overnight at least twice while living in parental or parental surrogate home'(48.9%). 4) The comorbid psychopathology of the subjects were frequently described as follows, in order of frequency:substance use(42.2%), ADHD(35.6%), depression(20.0%), tic disorder(11.1%), bipolar disorder(4.4%). 5) On MMPI, both Pd and Ma subscales got the highest scores. The mean of total IQ by KEDIWISC was $100.0{\pm}15.1$. Female subjects' IQ was higher than that of male subjects. 6) Regarding the number of visits to the OPD after discharge, many subjects(33.3%) had visited OPD fewer than four times. Conclusions:In this study, the male to female ratio of adolescent type showed a decreasing trend. An interesting finding was the fact that socio-economic circumstances, as well as the level of education among patients, were higher than those of previous studies. The subjects' problem were also principally self contered and posed no threat to others.

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Clinical observation for the Geriatric C.V.A. (노인(老人) 뇌졸중(腦卒中)에 대(對)한 임상적(臨床的) 고찰(考察))

  • Seo, Un-Kyo;Jeong, Ji-Cheon;Lee, Won-Chul
    • The Journal of Internal Korean Medicine
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    • v.14 no.2
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    • pp.50-70
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    • 1993
  • Clinical observation was done on 92 cases of Occlusive CVD, Cerebral hemorrhage (Subarachnoid hemorrhage) which were confirmed by Brain CT scan and observed for over 4 weeks, among the 121 cases which were more than 65 years of age. they admitted to the Dept. of Internal Medicine, Oriental Medical Hospital in Dong Guk Univ. from July 1992 to June 1993. The result were as follows; 1. In this study, Occlusive CVD was 74 cases, Cerebral hemorrhage (Subarachnoid hemorrhage was 2 cases) was 18 cases. 2. The ratio of male to female was 1.09:1. The age distribution showed the large number in the 65-69 year group(52.2%), 7th decade was 44.5% over 8th decade was 3.3% in ratio. 3. The site of Occlusive CVD was most common at MCA. the site of Cb-hemorrhage was most common at Basal ganglia. 4. The most common preceding disease was hypertension(47.8%) and the next were diabetes mellitus(14.1%), heart desease(14.1%). 5. Recurrence rate was 33.7% and 2nd attack was 20.7%, 3rd attack was 8.7%, 4th attack was 4.3% 6. Predisposing factors in Occlusive CVD were initiated usually during resting and sleeping, and that in Cb-hemorrhage were represented chiefly exercising(66.6%). 7. The smoker was 52.2%, the drinker was 32.6% in whole group. the drinker was 61.1% by the Cb-hemorrhage. 8. The ratio of the season distribution was as follow, fall 35.8%, winter 29.3%, spring 19.6%, summer 15.3%, that of the month distribution was november 15.2%. 9. Duration from on set in Occlusive CVD, 60.8% was within 5 days, that in Cb-hemorrhage, 77.8% was within 5 days. 10. Level of consciousness on attack was clear 42.2%, lethargy and mental change(dull, stupid etc.) 41.3%. The common symptoms were motor disturbance(90.2%), verbal disturbance(65.2%), headache(43.5%). 11. The physical theraphy of Occlusive CVD has been performed 75.7% in whole group and the average beginning time was 6.4 days, and that of Cb-hemorrhage has been performed 61.1% in whole group and the average beginning time was 13 days. 12. Duration of hospitalization was noted 11-20 days was 31.5%, over 21 days was 46.8%, and the average admission was 22.7 day(Occlusive CVD), 32days (Cb-hemorrhage). 13. The main complication were observed in the studies; urinary tract infection and pneumonia were noted in 6.5%, bed sore in 5.4%. 14. The ratio of systolic blood pressures in admission and discharge decreased from 58.7% to 28.3% in over 160 mmHg, that of diastolic blood pressures in admission and discharge decreased from 72.8% to 51.1% in over 90 mmHg. In 31(33.7%) of the 92 cases it showed the glucose levels of more than normal. 15. The patients have done family history of hypertension and C.V.A were 32.6% of all 16. Occlusive CVD In 83.8% and Cb-hernorrhage in 72.2% were improved 17. The herb medications were various Sunghyanggeonggisan, Sopungtang, CHunmagudeungeum were used most frequently and Gamidaebotang, Boyangwhanotang, Gagamyunjotang, Mangeumtang etc. were used as discharge.

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Comparision of Signal-Averaged Electrocardiography (SAECG) Determined by Flank Lead System (FLS) and Pyramidal Lead System (PLS) in Healthy Young Adults (정상 성인의 직교유도체제와 피라미드유도체제에 의한 신호 가산 평균심전도의 비교)

  • Jang, Byeong-Ik;Kang, Seung-Ho;Kim, Hyeung-Il;Shin, Dong-Gu;Kim, Young-Jo;Shim, Bong-Sup;Lee, Hyun-Woo
    • Journal of Yeungnam Medical Science
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    • v.10 no.1
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    • pp.179-189
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    • 1993
  • It has recently become possible to record electrical activity originating from abnormally conducting myocardium from the body surface with high - gain amplification and averaging technique. These signals, which result from delayed ventricular activation(late potentials), have been recorded in patients with documented ventricular tachyarrythmia. Several electrode lead system for detecting ventricular late potential were introduced. Pyramidal electrode lead system(PLS) is useful. Also interpretation of SAECG in the young could be of value in detecting those at risk for episodic ventricular tachycardia, but suffer from a lack of data in normal young people. Selection of subjects : For this study, normal healthy young adult volunteers (age: mean 24 years) were recruited from the medical students at Yeungnam University Hospital, Internal Medicine. Twenty fourths male and seventeenths female subjects were selected. All subjects had normal resting ECGs as judged from both the standard 12 channel lead and echocardiography, and none had a history of cardiovascular disease. All subjects were considered to be in good general physical condition. Signal-averaged electrocardiography : In order to obtain low noise recordings with a small number of averaging cycles, all subject ware asked to relax completely in the supine position. Silver/silver chloride electrodes were attached after the skin was cleaned with alcohol, to constitute classic flank lead system(FLS) and pyramidal lead system(PLS). Signals were recorded and processed using a commercially available microprocessor-augmented ECG cart(Marquette Electronics, USA) suitable for portable bedside recording. There was no difference between normal values, determined by FLS and PLS at high pass filtering of 25 Hz and 80 Hz, but significant, difference was found in HFLAD and RMS-40 of 40 Hz(p<0.05). These results will provide a basis for interpretations of SAECG, determined by FLS and PLS in healthy young adults with normal QRS duration.

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Analysis of Maternal and Neonatal Transport by the 1339 Emergency Medical Information Center in Busan Area (부산 지역 응급의료정보센터를 통한 산모와 신생아 전원에 대한 연구)

  • Kim, Mi-Jin;Lee, Myung-Chul;Yoo, Jae-Ho;Kim, Myo-Jing
    • Neonatal Medicine
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    • v.18 no.1
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    • pp.137-142
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    • 2011
  • Purpose: In relation to perinatal healthcare, medical institutions and resources are limitative and also are in a state of flux due to the therapeutic specialty. We analyzed requests for interhospital transfers received by Busan 1339 Emergency Medical Information Center (EMIC) to grasp the state of perinatal healthcare delivery system. Methods: This study was conducted on the basis of data inputted into the computing system of Busan 1339 EMIC, between January 1 and December 31, 2009. In connection with 378 pregnant women and 136 newborns who were required to transfer, retrospective analyses were made of the success rate of transfer (SR), the number of contacted hospitals, the time required for transfer and the reason of transfer and refusal. Results: In the case of pregnant women, the SR were 65.5%. They came in contact with 2.7 hospitals, and it took 24.4 minutes. As for the reason of transfer, preterm labor accounted for the highest proportion. In the case of newborns, the SR were 71.3%. They came in contact with 2.4 hospitals, and it took 15.6 minutes. The most common reason of transfer were respiratory symptoms. In the reason of refusal with pregnant women and newborn, the lack of medical staff, medical equipments and wards accounted for great. Conclusion: Many pregnant women and newborns have been transferred to hospitals by EMIC, but the SR has not been higher yet. Accordingly, there is a need to evaluate the propriety of perinatal treatment system, as well as to set up effective perinatal healthcare delivery system.

The Systemic Effects of Hypothermic and Normothermic Cardiopulmonary Bypass in Cardiac Surgery (심장수술시 저체온 체외순환과 정상체온 체외순환의 전신 효과에 관한 연구)

  • Park Jae Min;Cho Yong Gil;Hwang Yoon Ho;Lee Yang Haeng;Yoon Young Chul;Junng Hee Jae;Han Il Yong;Choi Seok Cheol;Cho Kwang Hyun
    • Journal of Chest Surgery
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    • v.38 no.1 s.246
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    • pp.29-37
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    • 2005
  • This study was prospectively designed to determine the physiologic effects of normothermic CPB and to compare its influences with hypothermic CPB. Material and Method: Thirty-six adult patients scheduled for el­ective cardiac surgery were randomly assigned to moderate hypothermic (hypothermic group nasopharyngeal tem­perature $26\~28^{\circ}C,\;n=18)$ ornormothermic (normothermic group, nasopharyngeal temperature > $35.5^{\circ}C\;n=18)$ CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after the start of CPB (CPB-10), and imme­diately after CPB stop (CPB-off) for determining total leukocyte counts, neuron-specific enolase (NSE), interleukin-6 (IL-6), endothelin-1 (ET-1), cortisol, troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, blood urea nitrogen (BUN), and the pulmonary index $(Pi,\;PaO_{2}/FiO_{2}),$Other parameters such as urine output, mechanical ventilating period, ICU-staying period, postoperative complications and hospitalized days were also evaluated. Result: Total leukocyte counts, increased rate in NSE, in IL-6 and in cortisol at CPB-10 and CPB-off were significantly higher in normothermic group than in hyphothermic group. Urine output during CPB was lower in normothermic group than in hyphothermic group. The duration of mechanical ventilation, ICU-stay, and hospitalization were longer in normothermic group than in hyphothermic group. Conclusion: These findings sug­gested that normothermic CPB caused higher inflammatory and stress responses than hypothermic CPB during car­diac surgery using cold crystalloid cardioplegia. However, further studies with large number of cases should be carried out to validate this hypothesis.

Effect of Acupuncture on Nasal Obstruction in Patients with Persistent Allergic Rhinitis: A Randomized Controlled Trial (지속성 알레르기비염의 비폐색에 대한 침치료의 효과: 무작위배정 대조군 연구)

  • Jo, Jeong-Hyo;Hong, Kweon-Eey;Kang, Wee-Chang;Choi, Sun-Mi;Park, Yang-Chun
    • Journal of Acupuncture Research
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    • v.22 no.6
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    • pp.229-239
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    • 2005
  • Objectives : Allergic rhinitis is a prevalent disease. Nasal obstruction is one of the main symptom in allergic rhinitis. It induces sleep disturbances, depression, attention deficit, memory impairments. Acupuncture treatment for rhinitis was mentioned in literature, but there is not enough report that provide evidence by well designed clinical study. The purpose of this research is to examine the effect of acupuncture treatment for nasal obstruction of allergic rhinitis. Methods : In this randomized, single blind, placebo-controlled study, we compared active acupuncture with minimal acupuncture for the treatment of nasal obstruction owing to persistent allergic rhinitis. Acupoints used in active acupuncture group were I120($Y{\hat{o}}nghyang$), GV23($Sangs{\hat{o}}ng$), IL4(Hapkok). Volunteers who satisfied the requirements were enrolled in study. Total nasal volume(NV) and total nasal minimum cross-sectional area(MCA) were measured by acoustic rhinometry before and after treatments(0min, 7.5min, 15min). Results : 101 subjects finished study. There were not difference between two groups on age, sex, weight, height, blood pressure, pulse, respiratory rate, severity of persistent allergic rhinitis, number of positive antigen. After treatment(0min) total NV were significantly increased compared with before treatment in active acupuncture group(p=0.0007) and minimal acupuncture group(p=0.0175). After treatment(15min) total NV of minimal acupuncture group was decreased compared with before treatment(p=0.2560), but total NV of active acupuncture group was maintained increasing in degree of borderline significance(p=0.0871). After treatment(0min) total NV were significantly increased compared with before treatment in active acupuncture group(0.0007) and minimal acupuncture group(p=0.0175). After treatment(Omin) total MCA were significantly increased compared with before treatment in active acupuncture group(p<0.000l) and minimal acupuncture group(p=0.0005). After treatment(15min) total MCA of minimal acupuncture group was decreased compared with before treatment(p=0.6082), but total NV of active acupuncture group was maintained increasing in degree of borderline significance(p=0.0929). Conclusion : Acupuncture treatment reduced nasal obstruction in persistent allergic rhinitis. Further study in the form of long term is needed.

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Evaluating the Impact of Attenuation Correction Difference According to the Lipiodol in PET/CT after TACE (간동맥 화학 색전술에 사용하는 Lipiodol에 의한 감쇠 오차가 PET/CT검사에서 영상에 미치는 영향 평가)

  • Cha, Eun Sun;Hong, Gun chul;Park, Hoon;Choi, Choon Ki;Seok, Jae Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.1
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    • pp.67-70
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    • 2013
  • Purpose: Surge in patients with hepatocellular carcinoma, hepatic artery chemical embolization is one of the effective interventional procedures. The PET/CT examination plays an important role in determining the presence of residual cancer cells and metastasis, and prognosis after embolization. The other hand, the hepatic artery chemical embolization of embolic material used lipiodol produced artifacts in the PET/CT examination, and these artifacts results in quantitative evaluation influence. This study, the radioactivity density and the percentage error was evaluated by the extent of the impact of lipiodol in the image of PET/CT. Materials and Methods: 1994 NEMA Phantom was acquired for 2 minutes and 30 seconds per bed after the Teflon, water and lipiodol filled, and these three inserts into the enough to mix the rest behind radioactive injection with $20{\pm}10MBq$. Phantom reconfigure with the iterative reconstruction method the number of iterations for two times by law, a subset of 20 errors. We set up region of interest at each area of the Teflon, water, lipiodol, insert artifact occurs between regions, and background and it was calculated and compared by the radioactivity density(kBq/ml) and the% Difference. Results: Radioactivity density of the each region of interest area with the teflon, water, lipiodol, insert artifact occurs between regions, background activity was $0.09{\pm}0.04$, $0.40{\pm}0.17$, $1.55{\pm}0.75$, $2.5{\pm}1.09$, $2.65{\pm}1.16 kBq/ml$ (P <0.05) and it was statistically significant results. Percentage error of lipiodol in each area was 118%, compared to the water compared with the background activity 52%, compared with a teflon was 180% of the difference. Conclusion: We found that the error due to under the influence of the attenuation correction when PET/CT scans after lipiodol injection performed, and the radioactivity density is higher than compared to other implants, lower than background. Applying the nonattenuation correction images, and after hepatic artery chemical embolization who underwent PET/CT imaging so that the test should be take the consideration to the extent of the impact of lipiodol be.

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Evaluation of useful treatment which uses dual-energy when curing lung-cancer patient with stereotactic body radiation therapy (폐암 환자의 정위적방사선 치료 시 이중 에너지를 이용한 치료 방법의 유용성 평가)

  • Jang, Hyeong Jun;Lee, Yeong Gyu;Kim, Yeong Jae;Park, Yeong Gyu
    • The Journal of Korean Society for Radiation Therapy
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    • v.28 no.2
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    • pp.87-99
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    • 2016
  • Purpose : This study will evaluate the clinical utility by applying clinical schematic that uses monoenergy or dual energy as according to the location of tumors to the stereotactic radiotherapy to compare the change in actual dose given to the real tumor and the dose that locates adjacent to the tumor. Materials and Methods : CT images from a total of 10 patients were obtained and the clinical planning were planned based on the volumetric modulated arc therapy on monoenergy and dual energy. To analyze the change factor in the tumor, Comformity Index(CI) and Homogeneity Index(HI) and maximum dose quantity were each calculated and comparing the dose distribution on normal tissues, $V_{10}$ and $V_5$, first ~ fourth ribs closest to the tumor ($1^{st}{\sim}4^{th}$ Rib), Spinal Cord, Esophagus and Trachea were selected. Also, in order to confirm the accuracy on which the planned dose distribution is really measured, the 2-dimensional ion chamber array was used to measure the dose distribution. Results : As of the tumor factor, CI and HI showed a number close to 1 when the two energies were used. As of the maximum dose, the front chest wall showed 2% and the dorsal tumor showed equivalent value. As of normal tissue, the front chest wall tumors were reduced by 4%, 5% when both energies were used in the adjacent rib and as of trachea, reduced by 11%, 17%. As of the dose in the lung, as of $V_{10}$, it reduced by 1.5%, $V_5$ by 1%. As of the rear chest wall, when both energies were used, the ribs adjacent to the tumors showed 6%, 1%, 4%, 12% reduction, and in the lung dose distribution, $V_{10}$ reduced by 3%, and $V_5$ reduced by 3.1%. The dose measurement in all energies were in accordance to the results of Gamma Index 3mm/3%. Conclusion : It is considered that rather than using monoenergy, utilizing double energy in the clinical setting can be more effectively applied to the superficial tumors.

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The Efficacy of Proximal Esophageal 24-hour pH Monitoring in Infants with Chronic Cough (만성기침을 동반한 영아에서 상부 식도 24시간 pH 검사의 유용성)

  • Kim, Yun Hee;Kim, Ja Kyoung;Kim, Jung Hee;Lim, Dae Hyun;Son, Byong Kwan
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1242-1247
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    • 2003
  • Purpose : Gastroesophageal reflux disease(GERD) is known as one of the most common causes of chronic cough, especially in children. The purpose of this study is to evaluate the efficacy of parameters from proximal esophageal 24-hr pH monitoring through its comparison with those of distal esophageal 24-hr pH monitoring that we generally use for diagnosis of GERD. Methods : We performed chest CT scans to find out the cause of chronic cough in infants with no clinical manifestation suggesting GERD. Then, in case that they had air space consolidation in posterior segment of both upper lobes and superior segment of both lower lobes(dependent position), we performed proximal and distal esophageal 24-hr pH monitoring. Results : The proximal and distal pH monitoring were performed in 17 infants(male 12; female five). The patients with positive pathologic reflux in proximal esophagus were 15 of 17(88.2%) and in distal esophagus were four of 17(23.5%). Reflux index and the total number of reflux episodes were statistically significantly lower in the proximal than in the distal esophagus(P<0.05). There was no correlation between each parameters of proximal and distal esophageal 24-hr pH monitoring. Conclusion : This study suggests that proximal esophageal 24-hr pH monitoring can be used as a very useful diagnostic tool in infants with chronic cough in which there are suspicions that it resulted from aspiration due to GERD.

A SURVEY OF SEDATION PRACTICES IN THE KOREAN PEDIATRIC DENTAL OFFICE (어린이의 치과치료시 약물에 의한 진정요법 사용에 대한 실태조사)

  • An, So-Youn;Choi, Byung-Jai;Kwak, Ji-Youn;Kang, Jeong-Wan;Lee, Jae-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.32 no.3
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    • pp.444-453
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    • 2005
  • Sometimes the dentists encounter a child who can not be treated with traditional behavior management techniques (for example, reward, restraint, Tell-Show-Do, familialization). In such a case, the dentists use sedation technique. Recently, in Korea, the use of sedation by pediatric dentists is increased. But, the guideline and survey of sedation is very insufficient. Now, we need a survey of sedation practice in Korea. We carried out research on the actual condition about sedation with a questionaire to pediatric dentists in Korea. Followings are the conclusions 1. Sixty six percent of pediatric dentists use sedative agents in their practice. In this study, using sedation shows an increase as compared with the past. 2. Determinative factors of using sedation were orderly behavior management, number of visiting, guidian's opinion, amount of treatment, general condition. 3. Distribution of ages in patients sedated with agents was orderly 3 years, 4-5 years, under 2 years, 6-10 years, more than 10 years. 4. Particular sedative drugs were chloral hydrate 60-70mg/kg, hydroxyzine 10-40mg/kg(25mg/kg), and oral route was the most favorable route. 5. Observation of skin and nail color, pulse oximeter were the most frequently utillized monitoring method during sedation. 6. Only fifty six percent of pediatric dentists complete the cardiopulmonary resuscitation course.

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